NPIMap

Organization Active NPI

Merrimack Medical & Walk in Center, LLC

  • Family Medicine Physician
  • Lawrence, MA
National Provider Identifier
1124337175
Registry record updated Jan 31, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MERRIMACK MEDICAL & WALK IN CENTER, LLC
Practice address
25 Marston St
3Rd Floor
Lawrence, MA 01841-2310
Phone
(978) 688-3100
NPI assigned
Sep 24, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
David Farzan, M.D.NPI 1093719924
Title
Partner
Phone
(978) 688-3100

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary
Urgent Care Clinic/Center 261QU0200X

Addresses

Primary practice location

25 Marston St
3Rd Floor
Lawrence, MA 01841-2310

Mailing address

25 Marston St
3Rd Floor
Lawrence, MA 01841-2310
Phone (978) 688-3100

Other names 1

  • MMWIC Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110412000599 MA Part B Supplier - Clinic/Group Practice 2769666999 Receives reassigned benefits from 3 practitioners
Practice locations: Lawrence, MA

National Provider Directory

National Provider Directory

Locations

25 Marston St
Fl 3
Lawrence, MA 01841
Phone (978) 688-3100

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1285286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1296432000000",
    "number": "1124337175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 MARSTON ST",
            "address_2": "3RD FLOOR",
            "city": "LAWRENCE",
            "state": "MA",
            "postal_code": "018412310",
            "telephone_number": "978-688-3100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 MARSTON ST",
            "address_2": "3RD FLOOR",
            "city": "LAWRENCE",
            "state": "MA",
            "postal_code": "018412310",
            "telephone_number": "978-688-3100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERRIMACK MEDICAL & WALK IN CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-24",
        "last_updated": "2011-01-31",
        "status": "A",
        "authorized_official_last_name": "FARZAN",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "978-688-3100",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MMWIC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Lawrence, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.